Nalidixic acid in children: retrospective matched controlled study for cartilage toxicity
Insights
Long-term use of nalidixic acid in children did not lead to joint problems. This finding suggests that quinolone-associated arthropathy is not a concern for pediatric patients, even with extended treatment.
Area of Science:
- Pharmacology and Toxicology
- Pediatric Infectious Diseases
- Rheumatology
Background:
- Newer fluoroquinolones offer effective oral treatment for Pseudomonas aeruginosa infections.
- Concerns exist regarding cartilage toxicity in children due to fluoroquinolone use, based on animal studies.
- Nalidixic acid, an early quinolone, demonstrated similar arthropathic effects in young animals but is approved for pediatric use.
Purpose of the Study:
- To investigate the long-term safety of nalidixic acid in children, specifically regarding the development of arthropathy.
- To assess whether historical pediatric use of nalidixic acid correlates with joint issues later in life.
Main Methods:
- Retrospective review of hospital charts for 11 pediatric patients treated with nalidixic acid (9-600 days).
- Follow-up examinations conducted 3-12 years post-treatment.
- Matched pair analysis comparing nalidixic acid recipients with controls who never received the drug.
Main Results:
- No significant difference in reported arthralgia between the nalidixic acid group (3/11) and the control group (3/11).
- Arthralgia in affected patients was deemed unrelated to drug therapy.
- All patients, in both groups, exhibited normal growth curves and normal functional and radiological joint findings.
Conclusions:
- Long-term nalidixic acid therapy in children does not appear to cause arthropathy.
- The study suggests that quinolone-associated arthropathy may not be a risk in pediatric populations, even with extended use.
- Findings support the continued use of nalidixic acid in pediatric patients where indicated.
Abstract:
The new fluoroquinolones allow effective oral therapy of infections due to Pseudomonas aeruginosa. Studies on efficacy and safety of these promising agents are not recommended in childhood because of cartilage toxicity which has been observed in growing animals. However, the first quinolone antimicrobial, nalidixic acid, showed identical arthropathic effects in young animals and is licensed for paediatric use. A review of the hospital charts revealed 11 patients who had received nalidixic acid over nine to 600 days and were available for control examination three to 12 years later. For each nalidixic acid case a carefully selected matched pair, who had never received nalidixic acid, was identically analyzed. Three patients from the nalidixic acid and three from the control group reported arthralgia, which was judged to have no relation to drug therapy. Growth curve and both functional and radiological joint findings were completely normal in all cases. These results suggest that quinolone-associated arthropathy does not occur in children, even after long-term therapy.
